REPUBLIC OF THE PHILIPPINES) Baguio City ) SS.

AFFIDAVIT OF DISCREPANCY IN NAME I, _________________________, of legal age, single, and with address at____________________, under oath, state: 1. THAT my name is _________________________as stated and registered in my birth certificate issued by office of the Civil Registry of ______________________. A copy of my birth certificate is hereto attached as ANNEX A; 2. THAT the name ______________________________-also appears in my passport which was issued based on the data appearing in my birth certificate. A copy of the page of my passport where my name and picture appears is hereto attached as ANNEX B; 3. THAT in the Petition for ____ dated ___ made by, my mother since childhood, my friends and acquaintances call me _________________and thus since then I have been accustomed to using the name __________________________in my personal records, transactions and communications; 4. THAT the name ________________________ and _______________________________ refer to one and the same person, the herein Affiant; 5. THAT I am executing this Affidavit to attest to the truth of the foregoing facts and to use the same for whatever legal purpose it may serve. IN WITNESS WHEREOF, I hereunto affix my signature this _________________ at Makati City. ___________________________________ Affiant SUBSCRIBED AND SWORN to before me this _______________ at__________, Affiant exhibiting to me his Passport bearing No. ______________________________ issued at ______________ on _________________. Doc No. ________; Page No. _______ ; Book No. _______; Series of ________